P11.83.B ONCO-FUNCTIONAL OUTCOME (OFO) AFTER RESECTION FOR ELOQUENT GLIOBLASTOMA (GLIOFO STUDY): A PROPENSITY-SCORED ANALYSIS OF AN INTERNATIONAL, MULTICENTER COHORT STUDY
Authors: J K W Gerritsen, R A Mekary, D Pisica, R H Zwarthoed, J L Kilgallon, N L Nawabi, C A C Jessurun, G Versyck, K P Pruijn, F L Fisher, E Larivière, L Solie, A Kloet, R Nandoe Tewarie, J W Schouten, E M Bos, T R Smith, C M F Dirven, M L D Broekman, A J P E Vincent, S De Vleeschouwer
Journal: Neuro-Oncology (2023)

Abstract BACKGROUND Minimizing residual tumor volume and preventing functional loss are the primary goal in glioblastoma resections in eloquent areas. However, their combined impact on patient outcomes remains poorly understood. We therefore developed a novel onco-functional outcome (OFO) classification and evaluated its benefit in subgroups based on age, preoperative neurological morbidity (NIHSS), and preoperative Karnofsky Performance Score (KPS). MATERIAL AND METHODS Propensity-score matching with a 1:1 ratio was used to match OFO 1 (no residual volume, no postoperative functional loss) vs. non-OFO 1 patients for the overall cohort and subgroups based on age, NIHSS, and KPS. Cox proportional-hazard regressions were performed to analyze the association between OFO class and postoperative neurological deficits, KPS deterioration, receipt of adjuvant therapy, overall survival, and progression-free survival. Logistic regressions were performed to analyze the predictive value of perioperative factors on OFO class. RESULTS Between Jan 1, 2010, and Oct 31, 2020, 3919 patients were recruited, of whom 858 with tumor resection for primary eloquent glioblastoma were included in analyses as the overall unmatched cohort. After propensity-score matching, the overall matched cohort comprised of 512 patients, of whom 256 received OFO 1 and 256 received non-OFO 1. In the overall matched cohort and matched subgroups, OFO 1 resulted in fewer postoperative neurological deficits at 6 weeks postoperatively (overall cohort: 10.2% vs. 25.8%, p &amp;lt;0.001), 3 months postoperatively (overall cohort: 12.7% vs. 9.9%, p &amp;lt;0.001), and 6 months postoperatively (overall cohort: 21.0% vs. 35.1%, p = 0.0010), lower rates of KPS deterioration at 3 months (overall cohort: 14.2% vs. 52.4%, p &amp;lt;0.001), and 6 months postoperatively (overall cohort: 26.5% vs. 52.9%, p&amp;lt;0.001), higher rate of receipt of adjuvant therapy (overall cohort: HR 3.91 [2.19-7.62], p &amp;lt;0.001), longer overall survival (overall cohort: median 21.0 months [19.0-25.0] vs. 13.0 months 12.0-15.5], p&amp;lt;0.001), and longer progression-free survival (overall cohort: median 10.0 months [9.0-11.0] vs. 7.5 months [6.0-8.0], p&amp;lt;0.001). Patients who underwent awake craniotomy more often received OFO 1 (43.0% vs. 26.9%, p &amp;lt;0.001), and awake craniotomy was an independent predictor for OFO 1 (OR 1.93, p = 0.0070). CONCLUSION OFO 1 is beneficial in patients with glioblastoma in eloquent areas to improve surgical outcomes, irrespective of age, preoperative NIHSS, or KPS, in terms of survival outcomes, functional outcomes, and receipt of adjuvant therapy. Furthermore, awake craniotomy was significantly associated with achieving this status. These results might aid neurosurgeons with their surgical decision making in individual patients, and they will be validated in the SAFE trial (NCT03861299) and the PROGRAM study (NCT04708171).